Evaluation of changes in biochemical composition of fetal brain between 18th and 40th gestational week in proton magnetic resonance spectroscopy

Urbanik, Andrzej; Cichocka, Monika; Kozub, Justyna; Karcz, Paulina; Herman‐Sucharska, Izabela

doi:10.1080/14767058.2018.1439009

Cited by 5 publications

(5 citation statements)

References 18 publications

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“…The physiological and gestational age-related variability of metabolite levels in healthy fetuses has been previously described in detail. According to Urbanik et al, a significant rise can be detected in NAA, Cr, Cho, and mI absolute concentrations throughout gestation (weeks 18–40) 7 . This observation is partly confirmed by Kok et al, also describing increasing NAA absolute levels between gestational weeks 30–41, further adding that, while NAA/Cr and NAA/Cho ratios also rise in the examined gestational period, Cho/Cr ratio decreases, suggesting that absolute metabolite levels do not elevate uniformly and with the same velocity throughout physiological neuronal maturation 13 .…”

Section: Discussionmentioning

confidence: 98%

“…However, the effect of the newborns’ postnatal age on the predictive value of H-MRS throughout the first weeks of life has not been studied in detail, albeit examination of all newborns with HIE in a uniform postnatal narrow age window is not plausible, due to variable clinical stability and available resources. Moreover, existing evidence proposes that metabolite ratios may also be affected by gestational age 7 . The influence of neither of these factors has been studied so far on the predictive value of H-MRS, even though accurate description of metabolite dynamics would be essential, especially by investigating metabolite ratios registered conventionally, to ensure generalizability.…”

Section: Introductionmentioning

confidence: 99%

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Predictive performance and metabolite dynamics of proton MR spectroscopy in neonatal hypoxic–ischemic encephalopathy

et al. 2021

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Background Prognostic value of proton MR spectroscopy (H-MRS) in hypoxic–ischemic encephalopathy (HIE) is acknowledged; however, effects of gestational age (GA) and postnatal age (PA) on prediction and metabolite levels are unknown. Methods One hundred and sixty-nine newborns with moderate-to-severe HIE were studied, having ≥1 H-MRS scan during postnatal days 0–14 and known neurodevelopmental outcome (Bayley-II score/cerebral palsy/death). Initial scans were categorized by PA (day 1–3/4–6/≥7), and metabolite ratios were compared by predictive value. Metabolite dynamics were assessed in a total of 214 scans performed in the study population, using regression modeling, with predictors GA, PA, and outcome. Results N-acetyl-aspartate (NAA)/creatine (Cr) and myo-inositol (mI)/NAA height ratios were consistently associated with outcome throughout the first 14 days, with the highest predictive value in the late (≥7 days) period (AUC = 0.963 and 0.816, respectively). Neither GA nor PA had an overall effect on these metabolite ratios, which showed strongest association with outcome (p < 0.001). Assessed separately in patients with good outcome, GA became a significant covariate for metabolite ratios (p = 0.0058 and 0.0002, respectively). However, this association disappeared in the poor outcome group. Conclusions In HIE, NAA/Cr and mI/NAA give most accurate outcome prediction throughout postnatal days 0–14. GA only affected metabolite levels in the good outcome group. Impact Proton MR spectroscopy metabolite ratios N-acetyl-aspartate/creatine and myo-inositol/N-acetyl-aspartate have persistently high predictive value throughout postnatal days 0–14 in newborns with hypoxic–ischemic encephalopathy, with the highest predictive power between postnatal days 7 and 14. Overall, neither metabolite ratio was affected by gestational age nor by postnatal age, while they showed the strongest association with neurological outcome. However, in newborns facing good outcome, metabolite ratios were associated with gestational age, whereas in cases facing poor outcome, this association disappeared. Proton MR spectroscopy provides valuable prognostic information in neonatal hypoxic–ischemic encephalopathy throughout the first 2 weeks of life, irrespective of the timing of MR scan.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Predictive performance and metabolite dynamics of proton MR spectroscopy in neonatal hypoxic–ischemic encephalopathy

et al. 2021

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“…Multiparametric approaches have potential value for quantitative evaluation fetal brain development. In proton magnetic resonance spectroscopy (H‐MRS), altered metabolite concentrations in the fetal brain may be associated with myelin formation 34 . The multiple parameters of diffusion were used to quantify microstructural changes in white matter and have been applied to fetal white matter development studies 35 .…”

Section: Discussionmentioning

confidence: 99%

“…In proton magnetic resonance spectroscopy (H-MRS), altered metabolite concentrations in the fetal brain may be associated with myelin formation. 34 The multiple parameters of diffusion were used to quantify microstructural changes in white matter and have been applied to fetal white matter development studies. 35 Yarnykh et al 36 used macromolecular proton fraction (MPF) mapping to quantitatively assess fetal brain myelination and concluded that myelin was the main determinant of MPF in brain tissue, and MPF mapping is sensitive to the early stages of fetal brain myelin formation and can be clinically applied.…”

Section: Measured the Apparentmentioning

confidence: 99%

Preliminary Study on Quantitative Assessment of the Fetal Brain Using MOLLI T1 Mapping Sequence

Jia

Liao

et al. 2022

Magnetic Resonance Imaging

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Background Prenatal quantitative evaluation of myelin is important. However, few techniques are suitable for the quantitative evaluation of fetal myelination. Purpose To optimize a modified Look–Locker inversion recovery (MOLLI) T1 mapping sequence for fetal brain development study. Study Type Prospective observational preliminary cohort study. Population A total of 71 women with normal fetuses divided into mid‐pregnancy (gestational age 24–28 weeks, N = 25) and late pregnancy (gestational age > 28 weeks, N = 46) groups. Field Strength/Sequence A 3 T/MOLLI sequence. Assessment T1 values were measured in pedunculus cerebri, basal ganglia, thalamus, posterior limb of the internal capsule, temporal white matter, occipital white matter, frontal white matter, and parietal white matter by two radiologists (11 and 16 years of experience, respectively). Statistical Tests The Kruskal–Wallis test was used for reginal comparison. For each region of interest (ROI), differences in T1 values between the mid and late pregnancy groups were assessed by the Mann Whitney U test. Pearson correlation coefficients (r) were used to evaluate the correlations between T1 values and gestational age for each ROI. Intraobserver and interobserver agreement was determined by the intraclass correlation coefficient (ICC). A P value <0.05 was considered statistically significant. Results Interobserver and intraobserver agreements of T1 were good for all ROIs (all ICCs > 0.700). There were significant differences in T1 values between lobal white matter and deep regions, respectively. Significant T1 values differences were found between middle and late pregnancy groups in pedunculus cerebri, basal ganglion, thalamus, posterior limb of the internal capsule, temporal, and occipital white matter. The T1 values showed significantly negative correlations with gestational weeks in pedunculus cerebri (r = −0.80), basal ganglion (r = −0.60), thalamus (r = −0.68), and posterior limb of the internal capsule (r = −0.77). Data Conclusion The T1 values of fetal brain may be assessed using the MOLLI sequence and may reflect the myelination. Evidence Level 3 Technical Efficacy Stage 2

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“…A recent cross-sectional study aimed to characterize the development of metabolite spectra during gestation and observed choline and myo-inositol peaks emerging first at 18 weeks gestation, followed by N-acetylaspartate and creatine peaks at 23 weeks; adjacent to the N-acetylaspartate, a glutamate signal was detected at GA 29. All metabolites increase in concentration with gestation (Urbanik, Cichocka, Kozub, Karcz, & Herman-Sucharska, 2019).…”

Section: Neuroimaging Targets For Biomarkers Of Neuropsychiatric Diseasementioning

confidence: 99%

Early magnetic resonance imaging biomarkers of schizophrenia spectrum disorders: Toward a fetal imaging perspective

Hayat

Sami

2020

Dev Psychopathol

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There is mounting evidence to implicate the intrauterine environment as the initial pathogenic stage for neuropsychiatric disease. Recent developments in magnetic resonance imaging technology are making a multimodal analysis of the fetal central nervous system a reality, allowing analysis of structural and functional parameters. Exposures to a range of pertinent risk factors whether preconception or in utero can now be indexed using imaging techniques within the fetus’ physiological environment. This approach may determine the first “hit” required for diseases that do not become clinically manifest until adulthood, and which only have subtle clinical markers during childhood and adolescence. A robust characterization of a “multi-hit” hypothesis may necessitate a longitudinal birth cohort; within this investigative paradigm, the full range of genetic and environmental risk factors can be assessed for their impact on the early developing brain. This will lay the foundation for the identification of novel biomarkers and the ability to devise methods for early risk stratification and disease prevention. However, these early markers must be followed over time: first, to account for neural plasticity, and second, to assess the effects of postnatal exposures that continue to drive the individual toward disease. We explore these issues using the schizophrenia spectrum disorders as an illustrative paradigm. However, given the potential richness of fetal magnetic resonance imaging, and the likely overlap of biomarkers, these concepts may extend to a range of neuropsychiatric conditions.

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Evaluation of changes in biochemical composition of fetal brain between 18th and 40th gestational week in proton magnetic resonance spectroscopy

Cited by 5 publications

References 18 publications

Predictive performance and metabolite dynamics of proton MR spectroscopy in neonatal hypoxic–ischemic encephalopathy

Predictive performance and metabolite dynamics of proton MR spectroscopy in neonatal hypoxic–ischemic encephalopathy

Preliminary Study on Quantitative Assessment of the Fetal Brain Using MOLLI T1 Mapping Sequence

Early magnetic resonance imaging biomarkers of schizophrenia spectrum disorders: Toward a fetal imaging perspective

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